bcheckform

VOLUNTEER IN YOUTH SPORTS

Consent/Release Form

Lugano hôtels NYSCA Chapter ID# __4887____

Name of Organization _________________________________________________

Sports you wish to coach_________________ ___

Applicants Name (printed) _____________________________________

Bournemouth alberghi b&bDate of Birth _________________________ Social Security Number __ ___________

Applicants Address ___________________________________________________________

City _______________________________State _________Zip __________

I, ____________________________, authorize and give consent for the above named

organization to obtain information regarding myself. This includes the following:

Employment records/ Employers references
Criminal background records/information
Criminal background check/fingerprint
Drivers license check
Oostende hotel roomsAutomobile insurance check
Training/experience
Personal references
Addresses

I the undersigned, authorize this information to be obtained either in writing or via telephone in connection with my volunteer application. Any person, firm or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information will be held in confidence in accordance with the organizations guidelines.

Print Name: __________________________________________Date:__________________

Signature: ___________________________________________________________________